Biomedical subjects

B Todd Moore

Publications and source records attributed to B Todd Moore.

3 recordsLinked to original sources

PubMed2005

Is trauma centre care helpful for less severely injured patients?

BACKGROUND: Trauma centres have been shown to reduce the number of preventable deaths from serious injuries. This is due largely to the rapid response of surgeons and health care teams to resuscitate, evaluate, and operate if necessary. Less is known about the effectiveness of trauma centre care on those patients who have not incurred immediate life-threatening problems and may not be as critically injured. The purpose of this study was to review the use of physician and hospital resources for this patient population to determine whether trauma team and trauma centre care is helpful or even needed. METHODS: This was a retrospective study of consecutive trauma patients (n=1592) admitted from 1998 to 2002 to the trauma service of an urban level I trauma centre and recorded in the hospital trauma registry. Patients were triaged in a tiered response to more or less severely injured. All patients' care was directed by trauma surgeons. RESULTS: Of the 1592 patients, 398 (25%) received a full trauma team response (Class I), 1194 were less seriously injured (Class II). The ISS for the Class I patients was 19+/-18 and for Class II patients 10+/-10. Nineteen percent of Class II patients had an ISS>15. Overall mortality in Class II patients was 2% including 20 unexpected deaths. Four hundred and three Class II patients (34%) had multisystem injuries. Of the Class II patients 423 (35%) were sent to the ICU or OR from the ED, 106 of whom required an immediate operation and 345 required an operation prior to discharge. Complications developed in 129 patients (11%), the majority of which were pulmonary. CONCLUSIONS: A large proportion of those patients thought initially to be less severely injured required resources available in a trauma centre, including specialty care, intensive care, and operating room accessibility. Over one-third of these patients had multisystem injuries and almost 20% were considered major trauma, needing prioritisation of care and expertise ideally found in a trauma centre environment. Complications developed in a sizable number of patients. This patient population, because of its heterogeneity and propensity for critical illness, deserves the resources of a trauma centre.

Adult↗

PubMed2004

Partial hepatectomy with or without endotoxin does not promote apoptosis in the rat liver.

BACKGROUND: Liver insufficiency and failure has been described following subtotal hepatectomy. The cause is poorly understood but may be because of attrition of hepatocytes through enhanced cell death pathways such as apoptosis. The trigger for this could be reduction beyond a critical mass of liver tissue or the influence of endotoxin (LPS) on cytokine activation. The experiment was designed to answer these questions. MATERIALS AND METHODS: Rats were subjected to either 30% or 70% hepatectomy. Sacrifice occurred on either postoperative day 2 or 4. At sacrifice remnant livers were examined for apoptosis through the direct Tunel immunoperoxidase method (apoptotic index) and soluble histone ELISA. A second group of rats underwent 30% or 70% hepatectomy and were given either saline or endotoxin (LPS). Sacrifice occurred on postoperative day 1, 2, or 4. Liver samples were analyzed for apoptosis by Tunel immunoperoxidase, histone-associated DNA, TNF-alpha, and caspase-3. Mitotic activity and evidence of hepatocellular necrosis were also determined. RESULTS: By comparison to prehepatectomy values, rats subjected to hepatectomy alone failed to disclose any effect of resection on apoptotic activity. By comparison to sham operated controls there was a modest but significant increase in apoptotic activity at day 4 in the 30% and 70% hepatectomized rates by apoptotic index but not the soluble histone ELISA. Injection of LPS without hepatectomy produced an increase in apoptotic activity by apoptotic index and soluble histone ELISA methods on day 1 and 2. The addition of 30% or 70% hepatectomy produced a sporadic, but not sustained, increase in apoptotic activity which may have been because of LPS injection alone. Tissue TNF-alpha levels increased with LPS but changed little with addition of hepatectomy. Mitotic activity remained essentially unchanged with or without LPS injection. No evidence of hepatocellular necrosis was detected with LPS and extended hepatectomy. CONCLUSIONS: Apoptosis does not appear to be a prominent feature in the posthepatectomy liver, with or without addition of LPS. Even with accelerated TNF-alpha production from LPS, the mitotic pathways continue to take precedent. Apoptosis, except for occasional sporadic bursts, is effectively suppressed. It is not likely that apoptosis contributes to depletion of functional hepatocytes and liver insufficiency.

Animals↗

PubMedDate not supplied

Trauma in the elderly.

As technology and medical care improve, older patients will be more active and productive at later ages. Falls and motor vehicle crashes will remain major mechanisms of injury in the elderly. Treatment of the elderly trauma patient must focus on their complex acute medical needs, their rehabilitation and social needs post trauma, and most of all prevention.

Accidents↗